Richard E. Link, MD, PhD

Richard E. Link, MD, PhD

Baylor College of Medicine

Houston, Texas

Richard E. Link, MD, PhD, is a professor and board-certified and fellowship-trained urologist specializing in the treatment of urologic disease affecting the kidney, ureter, adrenal gland and prostate. Dr. Link holds the Carlton-Smith Endowed Chair in urologic education at the Baylor College of Medicine (BCM) in Houston, Texas and directs the BCM division of endourology and minimally invasive surgery. He serves as director of living donor procurement for several major kidney transplant programs in Houston, including Baylor St. Luke’s Medical Center, Texas Children’s Hospital, and the Houston Methodist Hospital. Dr. Link focuses on the use of laparoscopic, robotic-assisted, percutaneous, and endoscopic techniques to treat kidney and prostate tumors, benign prostatic hypertrophy, renal and ureteral obstruction, and urinary tract stones and has been an early pioneer in the development of laparoendoscopic single-site donor nephrectomy.

Dr. Link earned both his MD and PhD in molecular and cellular physiology at Stanford University in California and completed an internship and residency at BCM before completing a fellowship at The Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Link also has a strong interest in applying single site robotic technology using the da Vinci SP platform to retroperitoneal and transvesical urologic surgery. He has published numerous papers and earned many awards, including the Fulbright and Jaworski LLP Faculty Excellence Award for Teaching and Evaluation at BCM.

Talks by Richard E. Link, MD, PhD

Alternative Access Approaches for Less-invasive Nephron-sparing Surgery

Alternative Access Approaches for Less-invasive Nephron-sparing Surgery

| Jan 2025

Richard E. Link, MD, PhD, explores advances in robotic kidney surgery, focusing on nephron-sparing approaches and alternative access strategies, specifically through the low anterior access with the SP (single-port) robot. Historically, while only about 10% of nephron-sparing surgeries employed the retroperitoneal technique due to challenges in positioning and multiport access, the advent of the SP robot has significantly altered this landscape.

In this 18-minute presentation, Dr. Link shares the low anterior access technique, which offers a versatile approach to addressing tumors located anywhere in the kidney—anterior, posterior, medial, or lateral—while minimizing the need for complex patient positioning. The primary advantage of this approach is reduced postoperative complications, faster recovery, and less pain, which are of greater importance to patients.

Data from Link’s practice indicate a marked increase in adopting retroperitoneal access using the SP robot, rising from 15% to 80% over recent years. This shift has led to a significant reduction in hospital stays and a streamlined surgical process, resulting in shorter operative times. Dr. Link shares video of the process and includes practical tips for optimizing this approach.

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Navigating the Shifting Landscape of Minimally Invasive Urologic Surgery in the Era of Single Site Robotics

Navigating the Shifting Landscape of Minimally Invasive Urologic Surgery in the Era of Single Site Robotics

| Jan 2024

Richard E. Link, MD, PhD, discusses the shifting landscape of minimally invasive urologic surgery in the era of single-site robotics. He describes the state of urologic minimally invasive surgery as a “messy toolbox,” with a huge diversity of technologies and techniques currently employed and a lack of consensus.

Dr. Link then ranks approaches based on invasiveness, with robotic single-port (SP) systems being the least invasive. He outlines benefits and drawbacks of various techniques and wonders if there has been a period of stagnation.

He then addresses advantages of the da Vinci SP system, with a softball-sized working envelope and a 360-degree rotation around its axis, its robotic dexterity, its ability to work through small incisions (2.7 cm), and its versatility for multi-quadrant surgery, as well as in working with extraperitoneal, retroperitoneal, and transvesical approaches. He lists disadvantages as well, including cost, scarcity, learning curve, and challenges with large specimens.

Dr. Link contends that development of the SP approach is driving an increase in extraperitoneal approaches (while laparoscopic and robotic advancements drove towards the transperitoneal approaches). He then explains the shift towards the retroperitoneal approach, which is more efficient and timesaving. Dr. Link lists anesthesia advantages of SP, including shorter procedures, lower risk of abdominal entry vascular and organ complications, less pain, and fewer incisions.

Dr. Link then explains that today the SP comprises the vast majority of his radical prostatectomies. He describes the new technology interplay between cost/availability, skills/training, patient benefits, and versatility/speed and acknowledges the tension between a new platform and a technique with which a practitioner is comfortable. Dr. Link predicts that costs will drop, availability will rise, and calls SP “the future.”

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